Provider Demographics
NPI:1093057101
Name:HOLMES, BRYAN LANIER SR (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:LANIER
Last Name:HOLMES
Suffix:SR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 MIDDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-7730
Mailing Address - Country:US
Mailing Address - Phone:912-347-0898
Mailing Address - Fax:
Practice Address - Street 1:185 MIDDLEWOOD DR.
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513
Practice Address - Country:US
Practice Address - Phone:912-347-0898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor